FORENSIC MEDICINE- INTRODUCTION

Presented by

Dr Mbwas Mashor

Consultant Pathologist, BhUTH, Jos Campus

August 1^st, 2022

FORENSIC MEDICINE

• Forensic pathology is not synonymous with forensic medicine
• Forensic medicine concerns the use of medical knowledge for the purposes of the law and the study of the law as it relates to medical practice
• The term “Forensic” was derived from “forum”, the Latin word for the market place

SCOPE OF FORENSIC MEDICINE

• Medical Jurisprudence- The law relating to medical practice
• Clinical Forensic Medicine
• Toxicology
• Forensic Pathology

MEDICAL JURISPRUDENCE

• Medical Acts and Medical Councils
• Medical certificates
• Dangerous Drugs
• Medical Ethics: Beneficience, non malefficience, Autonomy, Justice

CLINICAL FORENSIC MEDICINE

• Examination of hospital patients for the purpose of the law
• All hospital patients are potential medicolegal cases
• Clinical Forensic Medicine cases include:- Drunks, victims of Rape, Accidents and Industrial disease

TOXICOLOGY

• The study of the signs and symptoms of poisoning in the living and the recognition of poisoning in the dead
• Poison can cause sudden death and must therefore be excluded in all cases of sudden unexpected deaths

FORENSIC PATHOLOGY

Concerns the examination of the dead for the purpose of law

All the citizens of a country belong to the state

The state is therefore interested in the circumstances and the cause of death of the citizens.

FORENSIC PATHOLOGY

Examination of living or dead to determine/permit:

• Cause, mechanism, and manner of disease, injury, or death
• Identification of persons;
• Significance of biological and physical evidence;
• Correlation and reconstruction of wounds, wound patterns, and sequences; and
• Performance of comprehensive medicolegal death investigations

FORENSIC PATHOLOGY

Forensic pathology applies techniques of pathology to the needs and protection of public health, public safety, quality assurance, education in medicine, research, jurisprudence, and the administration of justice

Its highest goal is the development of strategies to prevent injury, disease, and death

CAUSE OF DEATH

Specific medical diagnosis denoting a disease or injury (e.g., myocardial infarction, strangulation, gunshot wound)

Proximate cause of death- the initial injury that led to a sequence of events that caused the death of the victim

Immediate cause of death- the injury or disease that finally killed the individual

MECHANISM OF DEATH

The mechanism of death describes the altered physiology by which a disease or injury produces death (e.g., arrhythmia, hypoventilatory hypoxia, exsanguination)

Coma- neurological causes

Asphyxia- respiratory causes

Syncope- cardiac causes

MANNER OF DEATH

Legal implications superimposed on biological cause and mechanism of death

1. Homicide

2. Suicide

3. Accidental

4. Natural causes

MEDICOLEGAL DEATH INVESTIGATION

Employs scientific methods and procedures with thorough review of all available investigative information

Requires a multidisciplinary team approach

Supported by law enforcement, investigative agencies, and specialist clinical/toxicological laboratories

Defined by statutes and regulations of the locale

MEDICOLEGAL DEATH INVESTIGATION

The law is interested in the circumstances of the death of all citizens in the country for at least three important reasons:

• To prevent cases of secret homicide
• To assist the state in the prevention of accidental deaths
• To facilitate accurate registration of the cause of death for epidemiological purposes

MEDICOLEGAL SYSTEMS

Forensic pathology services worldwide are organized into three major systems

• MEDICAL EXAMINERS SYSTEM
• THE PROCURATOR FISCAL SYSTEM
• THE CORONER’S SYSTEM

MEDICAL EXAMINER(ME)

• More than half of the states in the USA. ME is chair of Legal Medicine in the State University
• Two assistant MEs

Type 1- ordinary physician, the first at the scene of an incident

Type 2 - pathologist

• There are no inquests in the ME’s system.

PROCURATOR FISCAL (PF)

• Scotland and most of Europe
• Headed by PF who is qualified in law and who performs functions equivalent to those of DPP (Department of Public Prosecution) and Coroner
• There are two types of autopsies in this system-

Double Pathologist autopsy –murder cases

Single pathologist autopsy –all other cases

• Inquest with Sheriff, jury, and PF prosecutes the case. Cases that go to trial are also prosecuted by the PF

CORONER

• The oldest medicolegal investigative system, dating from 1194 in England
• UK, >1/2 of USA, and Commonwealth
• Magistrates, senior lawyers or senior doctors designated by State Governor or local government councils
• Assisted by police officers (Coroner’s officers)
• All cases reported to the local police station where the officers make preliminary investigations and later inform the Coroner.

DEATHS REPORTABLE TO THE CORONER- 1

• All sudden and unexpected deaths,
• All deaths associated with a diagnostic or therapeutic procedure
• All accidental deaths
• All suicides
• All homicides
• All deaths from poisoning.
• All employment-related deaths
• All epidemic-related deaths

DEATHS REPORTABLE TO THE CORONER- 2

• All deaths in prison or police custody
• All deaths from illegal abortion
• Unexpected/unexplained infant/child deaths
• All deaths in public/state institutions
• Unexpected deaths of public officials
• Where relatives are not satisfied with the circumstances and cause of death
• When the doctor cannot state precise cause of death or relatives disagree with stated cause of death

NOTIFICATION OF DEATHS TO CORONER

• Any person who finds a dead body should report the case to the nearest police station. Failure to do so is an offence in law
• Prescribed Coroner’s Ordinance Forms

Form B- Report of Death to the Coroner

Form C- Order to Medical Practitioner to perform Autopsy

Form D- Report of Medical Practitioner

CORONER’S AUTOPSIES

• No requirement for informed consent of relatives
• Death certificate can only be issued following clearance from Coroner
• Report must be issued to Coroner through police officer
• Report should be couched in simple language

CORONER’S INQUEST

• Public hearings where Coroner is President, Coroner’s officer prosecutes and relatives of deceased are represented by a solicitor
• Designed to answer four questions- i. identity of deceased, ii. date & place of death, iii. medical cause of death iv. circumstances of death
• The procedure is the same as in any court of law

CORONER’S VERDICT

• Natural causes
• Accidental death
• Misadventure
• Suicide
• Murder
• Manslaughter
• Infanticide

• Industrial disease
• Industrial accident
• Self neglect
• Abortion
• Alcoholism
• Open verdict

Relatives can appeal verdict at High Court

THANKS FOR LISTENING